Pediatrics

This article is about the branch of medicine. For the journal of the American Academy of Pediatrics, see Pediatrics (journal).

Overview

Clinical Examination

Pediatrics (also spelt paediatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents. The upper age limit ranges from age 14 to 21, depending on the country.

A medical practitioner who specializes in this area is thus known as a pediatrician (also spelt paediatrician); They may be either a DO (Doctor of Osteopathy) or MD (medical doctor).

The word pediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ιατρός (iatros = doctor or healer).

Differences between adult and pediatric medicine

Pediatrics differs from adult medicine in many respects. The obvious body size differences are paralleled by maturational changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and a host of other issues are of greater concern to pediatricians than they often are to adult physicians.

Some diseases, such as sickle cell anemia and cystic fibrosis are more often treated by pediatricians because only recently did the majority of these patients survive into adulthood. Issues revolving around infectious diseases and immunizations are also dealt with primarily by pediatricians. Put simply, treating a child is not like treating a miniature adult.

Childhood is the period of greatest growth, development and maturation of the various organ systems in the body. Years of training and experience (above and beyond basic medical training) goes into recognizing the difference between normal variants and what is actually pathological.

Another major difference between pediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure. In a sense, pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances only, though this is in legal flux and varies by region.

History of pediatrics

In the 10th century, the famous Persian physician Rhazes (Muhammad ibn Zakarīya Rāzi) wrote The Diseases of Children, the first book to deal with pediatrics as an independent field of medicine. For this reason, some medical historians consider him the father of pediatrics.[1] His teacher Ali ibn Sahl Rabban al-Tabari was also a pioneer in the field of child development, which he earlier discussed in his Firdous al-Hikmah.[2] The first work on pediatrics in the Western world was the Book of Children, written circa 1530 by Thomas Phaer, who was inspired by the works of Rhazes and Avicenna.[3]

Pediatrics as a separate area of medical practice in the Western world largely began in the nineteenth century. The Hospital for Sick Children, Great Ormond Street (London) was founded in 1852, and is probably the oldest such children's hospital in the English-speaking world. Great Ormond Street is adjacent to Coram's Fields, the site of the much earlier Foundling Hospital. The emigrant German physician, Abraham Jacobi, worked in the same period and is often considered the father of American pediatrics.

Training of pediatricians

Like other physicians, pediatricians begin their training with an entry-level medical education: a tertiary-level course, undertaken at a medical school attached to a university. Depending on jurisdiction and university, this course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years. Entrants to graduate-entry courses, usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".

Pediatricians must undertake further training in their chosen field. This may take from three to six or more years, depending on jurisdiction and the degree of specialization. The training for a primary care physician, including primary care pediatricians, is generally not as lengthy as for a hospital-based medical specialist.

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of pediatric organizations (see below) rather than universities, with varying degrees of government input, depending on jurisdiction.

"Pediatrician" versus "Paediatrician"

There is a slight semantic difference associated with the difference in spelling. In the USA, a pediatrician (US spelling) is commonly a primary care physician, or general practitioner, who specializes in children. A similar situation exists in Germany: a kinderarzt is commonly a primary care pediatrician.

In the Commonwealth and in much of the rest of the world, a paediatrician (British spelling) is normally a specialist physician not in primary general practice: he or she sees patients who are either urgently admitted to a hospital or who are referred by general practitioners. A paediatrician in this sense could fairly be described as an internist who has subspecialized in infants & children, and usually had longer post-graduate training in child health than a primary care pediatrician.

Subspecialists in pediatrics

Specialist pediatricians may undergo further training in sub-specialties. Practising a subspecialty in pediatrics is similar in some respects to practising the relevant adult specialty, but a major difference is in the pattern of disease. Typically, diseases commonly seen in children are rare in adults (egbronchiolitis, rotavirus infection), and those seen in adults are rare in children (egcoronary artery disease, deep vein thrombosis). Hence, pediatric cardiologists deal with the heart conditions of children, particularly congenital heart defects, and pediatric oncologists most often treat types of cancer that are relatively common in children (eg certain leukemias, lymphomas and sarcomas), but which are rarely seen in adults. Every subspecialty of adult medicine exists in pediatrics (with the obvious exception of geriatrics).

Adolescent medicine is a growing sub-specialty. The pattern of diseases in adolescents in part resembles that seen in older adults, and specialists or sub-specialists in adolescent medicine are also drawn from practitioners of internal medicine or family medicine. Another major sub-specialty, which is unique to pediatrics, is neonatology: the medical care of newborn babies.

Social role of pediatricians

Like other physicians, pediatricians are traditionally considered to be members of a learned profession, because of the extensive training requirements, and also because of the occupation's special ethical and legal duties.

Pediatricians commonly enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners in general often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length. Neonatologists or general pediatricians in hospital practice are often on call at unsociable times for perinatal problems in particular — such as for Caesarean section or other high risk births, and for the care of ill newborn infants.

The U.S. Bureau of Labor Statistics estimates that general pediatricians earned an average of $141,440 in 2006.